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Given the dearth of research exploring mental health differences between rural and urban men who have sex with men (MSM), we sought to examine differences in depressive symptomology and loneliness. Concurrently we examined the mediating effects of loneliness on the link between geographic locale and depressive symptoms via a mediation model. Data were collected from 156 MSM in Oklahoma. Results show urban MSM have significantly higher levels of both depressive symptomology and loneliness. Mediation analyses revealed that the link between urban/rural locale and depressive symptomology was mediated by loneliness. In other words, identifying as urban MSM may result in higher levels of depressive symptomology through feelings of loneliness. The rationale for this includes the possibility that rural MSM may have strong online social support 'networks' which act as a protective factor against loneliness and depressive symptomology, or that elements of urban environments increase stress in urban MSM. It is also possible that the urban landscape of Oklahoma does not provide the same level of acceptance as other urban areas in more liberal parts of the country. Interventions at the individual or community level should consider geographic location as a mesosystem factor that impacts the mental health of MSM. [ABSTRACT FROM AUTHOR]

Rural men who have sex with men (MSM) are particularly vulnerable to HIV/STI infections, though most outreach efforts to reach MSM have been focused on urban populations. More attention is needed to study effective ways of reaching/recruiting rural MSM, yet little is known about their preferences; particularly as studies show significant differences in the behaviors and perceptions of rural versus urban MSM. Our study uses a qualitative instrument to gauge what outreach methods are most effective from the perspective of 40, rural MSM. Outreach facilitators included online marketing, emphasizing rural areas, while outreach barriers included traditional forms of print media/advertising, or anything that may jeopardize anonymity. Implications for future outreach in rural areas and limitations are also discussed. [ABSTRACT FROM AUTHOR]